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Texas Perinatal Services is thrilled to bring the Institute for Perinatal Quality Improvement’s popular Perinatal Quality Improvement Conference to Texas. The conference will be Oct. 11 at Texas Health Dallas Margot Perot Building in the Fogelson Auditorium. The hospital is located at  8160 Walnut Hill Lane in Dallas.

Headlining this highly rated education event is the Institute’s Founder and Executive Director Debra Bingham, DrPH, RN, FAAN. She was our featured speaker for the TPS Perinatal Forum in June. Also on the program is Texas Perinatal Services Perinatal Program Director Carla Rider, DNP, MBA, RNC-LRN. Carla was recently named to the Institute’s Executive Advisory Board.

During the day, participants will:

• Hear about the state of perinatal quality and safety;
• Learn how to set perinatal quality and safety goals, and design perinatal quality improvement initiatives, and
• Review examples of quality and safety initiatives.

Breakfast, lunch and breaks are included through TETAF’s sponsorship. Participants can earn 5.75 hours of CNE credits for attending.

Best of all, TETAF/Texas Perinatal Services contracted hospitals can take advantage of significant discounts on conference registration if booked by Sept. 5.  Use the registration code TETAFTPSCLIENT to save $50 off regular registration fees.

For more information, view the agenda and register by Sept. 5 for the special rate.

The Texas Legislature gaveled to a close late last month. What action did legislators take on maternal mortality and morbidity issues? Here’s a summary of key activity.

Legislature Modifies Neonatal/Maternal
Designations Requirements

On May 25, the Texas Legislature sent Senate Bill 749 by Sen. Lois Kolkhorst (R-Brenham) to the governor for his review/approval. The bill establishes contingency surveys, a waiver process and an appeals process for maternal level of care certifications. The bill also extends the date for hospitals to complete maternal designation until Aug. 31, 2021. The bill also clarifies that the rules regarding the use of telemedicine by Levels I, II and III facilities must be made in consultation with physicians, hospital associations, DSHS and other “appropriate interested persons.”

House sponsor Rep. Four Price (R-Amarillo) offered two amendments on the House floor relating to the waiver process, which were approved. One amendment requires the hospital to give notice of its intent to seek a waiver to the hospital’s medical staff members who practice in a specialty service area affected by the waiver. The second clarified that the department can determine the waiver is justified after considering the expected impact on the accessibility of care in the geographic area served by the hospital if a waiver is not granted, and quality of care and patient safety. The Senate concurred with the House amendments.

The deadline for hospitals to have a designation level of maternal care was extended until Aug. 31, 2021. The requirement of a hospital having a maternal level of care designation to obtain Medicaid reimbursement was extended until Sept. 1, 2021. The bill allows hospitals to pursue designation before the deadlines, and to amend any application filed prior to the effective date of the bill, if necessary to comply with new provisions in the law. Texas Perinatal Services already has conducted several surveys and has many other scheduled.

The bill makes the Texas Perinatal Advisory Council subject to sunset review in conjunction with the evaluation of the Texas Department of State Health Services. In consultation with the PAC, the agency must conduct a strategic review of the practical implementation of the rules for NICU and maternal care designation, identifying barriers to a hospital obtaining its requested level of care designation. The review also must look at requirements for a level of care designation that relate to gestational age; and if designation determination should consider the hospital’s geographic location or the number of patients of a particular gestational age treated by the hospital and the hospital’s capabilities in providing care to patients of a particular gestational age. Based on the findings, the review also would include recommendations for modification of the rules to improve the process and methodology of assigning levels of care designation.

A written report on the review of neonatal care must be submitted to the Legislature by Dec. 31, 2019, and one on the review of maternal care by Dec. 31, 2020.

TETAF and Texas Perinatal Services will be very involved in the rulemaking process as SB 749 is implemented. Since the bill passed both chambers with super majorities, it takes effect immediately upon the governor’s signature, and TETAF/TPS will push for prompt rulemaking.

Legislature Approves Study of Postpartum Depression

House Bill 253 by Rep. Jessica Farrar (D-Houston) has been sent to the governor by the Legislature. The bill requires the Texas Health and Human Services Commission to develop a five-year strategic plan to improve access to postpartum depression screening, referral, treatment and support services.

The plan must provide strategies to:

• increase awareness about the prevalence and effects of postpartum depression among state-administered program providers who serve women at risk;
• establish a referral network of community-based mental health providers and support services addressing postpartum depression;
• increase women’s access to formal and informal peer support services, including certified peer specialists who have received additional training related to postpartum depression;
• raise public awareness of and reduce the stigma related to postpartum depression; and
• leverage sources of funding to support existing community-based postpartum depression screening, referral, treatment and support services.

In developing the strategic plan, the Texas Health and Human Services Commission is required to coordinate with the Texas Department of State Health Services, the statewide health coordinating council, the office of mental health coordination and the statewide behavioral health coordinating council. This group must annually review the strategic plan and update it as needed.

Maternal Mortality Register Bill Dies

House Bill 2703 by Rep. Shawn Thierry (D-Houston) would have created a workgroup of stakeholders to provide recommendations on the type of maternal mortality and morbidity data that should be collected by the state, and the time spans to be covered. The bill was heard in the House Public Health Committee and was reported favorably. It died in the House Calendars Committee.

The governor has until June 16 to veto bills.

Texas Perinatal Services maternal surveyors are 100 percent Texas-based, Texas-experienced maternal health clinicians. In our ongoing Meet the Surveyor series, we introduce you to surveyor Nathan Drever, M.D.

March marks one year since the state’s new maternal verification rules came into effect.  What has been the greatest impact of the rules in your perspective, in this first year?

One of the things that has been beneficial for me as a maternal medical director in labor and delivery is the new rules have allowed me and my hospitals to highlight the mechanisms in place that meet the rule. It’s easier to get buy-in from providers across a big system when things are categorized or listed or documented by the state. So it has been helpful for the state to come out with those rules and some instructions on how to meet those metrics.

As a surveyor, I think what’s had the most impact is knowing that other labor and delivery units are all trying to organize themselves the same way that you are. It’s good to see how they are brainstorming as a group to tackle things that sometimes are hard to implement, and also to see different perspectives on how to design your own labor and delivery unit. But because every place is so different, that scaffolding may not be the same from place to place, but you have a blueprint on how to build it. We are all working toward the same goal.

Why did you choose to become a surveyor?

My favorite place to be is in labor and delivery. I wanted to become a surveyor because I wanted to know how to do a top-down assessment of a labor and delivery unit. I wanted to understand what the state of Texas views as important to have to make us a safe site. I wanted to see how other units are getting their work done, and that’s helpful to me in my labor and delivery here locally.

And why with TETAF/Texas Perinatal Services?

I was involved with the NICU survey when it was done here and I went to the morning session where the TETAF surveyors interacted with all the team. I liked the way TETAF’s surveyors interacted with the staff, and how they talked about the potential deficiencies and how to remedy those deficiencies. I liked how they conducted themselves, and their philosophy of surveying with a goal of helping the hospital improve on what it is doing.

How would you describe your role as a surveyor – what is your focus, and what is a typical day like while onsite conducting a survey?

I consider myself the eyes of the state of Texas. I’m observing how things are done and I am reporting back to the state.

When we show up, everyone is usually pretty tense and a little anxious about the process so we try not to contribute to the anxiety. I really think in terms of this:  “I want to show you off, I want to find things you guys do well that I can brag about on you, and I want to see if there are any things that could be improved.”

A typical day one starts around 1 p.m. and we chart review until 6 or 7 that evening and sometimes later. That is the most time-consuming part, going through medical records and finding what you need to complete your survey sheet. Then the next day, we get there at 8 a.m. and talk in an open meeting for about two hours with a lot of individuals. We then spend about two hours doing a walkthrough of areas that we think would be informative. We close by giving give them our report. We always start off potential deficiencies, and steps you can take to remedy them. And we wrap up with the things the hospital is doing very well.

Are you seeing some common areas of potential deficiencies?

Common areas of potential deficiencies, and the easiest to address, are guidelines to maternal morbidity and mortality – hypertensions, shoulder dystocia, behavioral health, and so on. Some hospitals have some of those guidelines but not all, but you also have to follow internal policies. They might have guidelines in place for certain things, but don’t have it fully defined, or they aren’t following the guidelines.

The other thing that we all struggle with is the quality process and how to do outreach. Most labor and delivery units do identify problems and how to fix them, but we aren’t always good at tracking to make sure the steps we took worked. A lot of labor and delivery units are holding group quality meetings to assess problems and improvement plans all the time, but if you aren’t taking attendance and minutes and showing that you are implementing changes, it doesn’t look like that. It is important to document what you already are doing. That feedback loop is important before the maternal level designation.

What advice do you have for hospitals preparing for their first survey?

From a logistical standpoint, it is helpful to have a really good electronic medical record system that is fully integrated, but that’s something you either have or you don’t. One facility we surveyed had five different systems to navigate just to get the charts.

Keep in mind that the steps we are taking that we think are going to make us safer are slow, deliberate steps. You have to give yourself enough space and time to get everyone on board and have feedback and understand how the process works. If you can do it slowly and deliberately, you can gradually work these safety features in, and then move to the next one. What sometimes happens is a hospital tries to do everything that the state says we have to do two or three months before the survey. But the survey team goes back a year and is surveying charts before any of those things are in place. The concern is that if you rush to all these changes it might not be something that becomes part of the culture that embraces those changes.

About Nathan Drever

Nathan Drever, M.D., is board-certified in both Ob/Gyn and Maternal Fetal Medicine and has been providing maternal health care in Texas since 2009. He currently serves as medical director of labor and delivery at Scott and White Medical Center in Temple. He trained in two county hospital systems that managed high-risk OB patients and were both referral centers for severe maternal disease and preterm infants.

One thing that sets Texas Perinatal Services apart is its 100 percent Texas-based, Texas-experienced surveyors. In our ongoing series of Conversations with TPS Surveyors, we are pleased to introduce another one of our exceptional maternal surveyors, Kathleen Rasmussen, M.D., Ph.D.

Her two decades of OB/GYN experience span all levels of care delivery, from private practice to clinical leadership roles across the Corpus Christi region. We recently talked with her about the new maternal care verification surveys and what hospitals can expect.

It’s coming up on one year since the state’s new maternal levels of care designation rules came into effect.  In this first year, what has been the greatest impact of the rules in your perspective?

The rules are very specific about what the hospitals need to do and to provide if they are going to be designated at each level. That has been very helpful. It is making all hospitals really look at those rules carefully and be sure they are providing at that level. We never had to do that before.  Here locally, our facilities are viewing these like Joint Commission surveys. We want to be prepared, be able to show what we are doing, and make sure we have very good documentation.

Why did you choose to become a surveyor? 

I gave it a lot of thought because I have a lot on my plate. But to be honest, the data that has come out about Texas’ high rate of maternal morbidity and mortality compared to other states really bothered me. I felt that by saying yes to being a surveyor, I could be a part of making a difference.  It’s also a great opportunity for me to see what other hospitals in the state are doing, and bring that back to my facility.

I knew of TETAF because we have a Level 2 trauma center and a stroke center, and have been surveyed by TETAF. Our facility has great respect for TETAF, and I feel honored to be a part of the organization.

How would you describe your role as a surveyor – what is your focus, and what is a typical day like while onsite conducting a survey?

TETAF did a great job of getting us ready as surveyors. They reviewed the rules for us, explaining them so that we could be confident in explaining them ourselves as surveyors. We also went over the tools that we would use the day of the survey, and received good training on what we are supposed to do when we go into a facility.

Our goal as TETAF/TPS surveyors is to be very objective. The first day it’s all business – chart reviews, policies, procedures, documentation, outcomes, asking a lot of questions. The first day is very intense. We finish up in the early evening, and then the surveyors meet as a group to go over that first day.

The second day is a question-answer format to go over concerns from the day before. We then also address all of the services — laboratory, radiologists, pharmacists, behavioral, clerical, and so on. The hospital administration is there, physician leaders are there. Our focus is on seeing if they are following their policies and procedures, and whether the hospital is following what the rules require.  A part of our role is making the hospital aware of where it has potential deficiencies, and helping clarify the rules for the staff.

Then we have a closing session where we meet with the leadership team. We emphasize the hospital’s strengths, review what we saw as weaknesses, and make recommendations on how the hospital could improve. We are there to help the hospital, and to bring them up to the top of their game. We want all the maternal care facilities to do that. Our focus is not to be punitive but to help the hospital be where and what it wants to be.

We’ve heard a lot about the importance of hospitals planning ahead for their survey. What steps have you seen that worked particularly well to help a hospital be very well prepared?

Readiness of the team on the first day of the survey is critical. Be prepared to show where the data are and where the documentation is. Have your act together, coach and train your staff to be able to do the chart reviews. I would recommend actually practicing some chart reviews in advance. Go through the EHR and the data and be ready to do that during the survey. That helps us be more efficient in getting through the chart reviews, and really sets the tone for organization and planning.

Also, have all the procedures and policies well organized and have a point person there who knows where everything is, and can access anything the surveyors ask for. Have your QAPI minutes very well organized in binders in the room for us, where the surveyors can just pull them off the shelf.  Also involve your physicians in the process; the medical director needs to be involved early on, don’t wait until the last minute to get physician involvement. And, most importantly, study the rules. You can’t get away from them, no exceptions.

About Dr. Rasmussen

Texas Perinatal Services maternal surveyor Kathleen Rasmussen, M.D., Ph.D., has been providing women’s health services for two decades. She has been a department chair for OB/GYN departments in Utah, and atChristus Spohn South Hospitals for several years. She also has been the vice president for medical affairs at Spohn for several years. Currently she is the regional director for women’s medical services for Christus Spohn South, Alice, Beeville and Kleberg Hospitals.

Texas Perinatal Services maternal verification surveyors are 100% Texas-based, Texas-experienced clinicians, who understand the unique challenges of delivering maternal care in such a large and diverse region. We are excited to introduce you to another one of these exceptional Texas surveyors, Dr. Sireesha Reddy. Read what she has to say about the value of maternal verification surveys, and steps your hospital can take to prepare for its survey.

Sireesha Reddy, M.D., is a board-certified obstetrician and gynecologist in El Paso who is professor and chair of the department of obstetrics and gynecology, with a secondary appointment in pediatrics at Texas Tech University Health Sciences Center El Paso. Her clinical focus is in the care of pediatric and adolescent gynecology patients. She is one of the exceptional maternal surveyors on the Texas Perinatal Services team.

Here are her insights on the maternal levels of care verification surveys and how hospitals can prepare for them.

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How will hospitals, and more importantly their patients, benefit from the new maternal care verification surveys and designation rules?

The survey is an important aspect of assessing how hospitals are preventing maternal mortality.  This should be a key organizational priority for all labor and deliveries in the hospital. Verification surveys make hospitals accountable, ensuring safe care and concerted effort that their patients can access appropriate care. The maternal verification surveys give the state insight as to how hospitals in various regions provide care to mothers, and hopefully, with time, there brings some standardization across the board and resources to regions that do not have the level of care they need for their region.

Why did you choose to become a surveyor?

I chose to become a surveyor because I think collaboration is key. It is a great opportunity for me to learn how other hospitals are providing care. So in a way, it helps me to gauge how I am providing care in my region.  I see how others are doing things better, and see how we can do better. At the same time, it’s a passion of mine to make sure that women have high levels of care through their life span, recognizing that the greatest risk is through the childbearing years.

As a surveyor, I recognize how collaboration plays a role in getting buy-in and implementation of guidelines. Certainly the hospital is the one that is implementing this care, but they do this with the auspices and guidelines from other entities. So many individuals and departments have key roles in hospitals to improve care and outcomes.

The maternal care survey is an opportunity for hospitals to show what they do well. It is very exciting as a surveyor to go to a location and see how the individuals there want to show you how well they do things. I am not there to critique their management of patients.  I want them to show me what they do well.

What is special about TETAF/Texas Perinatal Services?

TETAF has a great reputation for surveying and a standardized process for surveying. From my initial surveyor training with TETAF, it was clear that they understand surveyors’ anxiety, and were very supportive. They were able to demonstrate their own expertise in chart reviews and their expert understanding of the intricacies of the maternal rules for hospital designation. TETAF is an expert in surveying hospitals. They were involved in trauma and neonatal hospital designation.  They have a rich history in working with hospitals. The interesting and cohesive part is that they have the ability to bridge the process between these designations even if it is trauma or neonatal. They have an understanding that there is a commonality in all designations and  that can bridge specialties to make processes in other areas better.

What experience(s) do you bring to your role as a surveyor that you hope will be beneficial to the hospitals and clinical teams you survey?

As a chair and leader in my department, we are constantly holding ourselves accountable through safety and quality initiatives. My experience is that I have an understanding of the maternal rules for hospital designation, various guidelines to reduce maternal mortality and morbidity and national initiatives to improve maternal outcomes. As a leader, I want the community to be able to trust us. So understanding our responsibility in the community is a value as a surveyor.

The maternal care surveys are new to hospitals; what advice can you offer them as they prepare for the process?

If the hospital has a quality team, tightening up those processes is valuable. The questions they should ask themselves: what have we done well, and not so well, what can we do better? The hospital should understand their strengths and weaknesses, and put things in place to address those weaknesses. I would suggest calling the hospitals that already have gone through the survey process. They should ask their NICU or nursery leaders who went through their surveys, what was their process, and what would they do differently or the same if they had to go through the survey again. I would suggest performing a mini mock survey of their own processes so they can see what they do well and don’t do well.  I would strongly
recommend looking at the maternal designation rules, line by line and understand what those rules mean. If the hospital doesn’t understand what the rules mean, call the state. Prepare, prepare, prepare and question, question, question.

At Texas Perinatal Services, we pride ourselves on hiring only Texas-based, Texas-experienced clinicians for our survey teams. In our ongoing series of Conversations with TPS Surveyors, we are pleased to introduce another one of our exceptional maternal surveyors, Gloria Delgado, MSN, RNC-OB.

Gloria brings more than two decades of experience in leading and delivering women’s health care services in Texas. Here are some of her observations about the new survey process and what hospitals can expect.

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How will hospitals, and more importantly their patients, benefit from the new maternal care verification surveys and designation rules?

For most of my career, maternal/child care services were not considered as important as other services. With the new rules, we finally are at the point of being at the front-row in terms of the importance of safety and quality care for maternal patients.

Most people think being pregnant is easy and everything with the delivery will be fine, but that isn’t always the case. Having these levels of care helps the public understand the levels of care and how they help in managing a high-risk pregnancy. By having these designations, for example, the ambulance driver knows the best place to take the patient based on their needs for a safe delivery.

Why did you choose to become a surveyor?

I’ve always been impressed with the knowledge that Joint Commission surveyors had. So, I felt being a maternal surveyor would be a great way for me to learn and be a better patient care provider, so it was selfish in a way. But I also wanted to contribute something for the state.

Here in El Paso, we are far away from the major metro areas and I saw this as an opportunity to collaborate to improve the quality of care for the whole state. I also believe that, because Texas has so many deliveries, just by changing the quality of care here in Texas, we can change national statistics on maternal care and that’s very powerful.  It’s empowering to try to help every provider be better, not in a criticizing way but in a collaborative way, so that we can provide better care the next time. I want to be part of this change

Why with TETAF?

To be a TETAF/Texas Perinatal Services surveyor, you first have to be recommended. I was recommended by a colleague, and was thrilled to be selected and to be trained. TETAF has been at the forefront of working to improve care in Texas, from trauma and stroke services, to now perinatal services. They have a strong reputation for doing good surveys, and a long history of doing these kinds of surveys. I wanted to be trained well and I knew that I would get that with TETAF.

What experiences do you bring to your role as a surveyor that you hope will be beneficial to the hospitals and clinical teams you survey?

I’ve been a nurse for 22 years and have served in a variety of roles. I started as a staff nurse and then was an educator for five years. And then later as a manager, I was able to get the bigger picture, making sure that everyone meets requirements, that HCAHPS scores are maintained, etc. Having done all of those roles as a staff nurse, educator and manager, I feel I have a good perspective and can help other hospitals and individuals in each one of those positions.

The maternal care surveys are new to hospitals; what advice can you offer them as they prepare for the process? 

Prepare as though it is a Joint Commission survey. Expect it to be as intense as a Joint Commission survey. The survey team will review lab, radiology, dietary, case management, and so on. The people surveying us are people who are working in the perinatal world so they know what to look for, and they will uncover any weaknesses.  Begin planning early and take advantage of the tools that are online from the DSHS website, like the gap analysis, and from the Texas Perinatal Services website.

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About Gloria Delgado

Gloria Delgado, MSN, RNC-OB, has 22 years’ experience in women’s health services. She has held positions as labor and delivery staff nurse, women’s services nurse educator, unit director and director of women’s services. She received her BSN from The University of Texas at El Paso, and a master of science in nursing and healthcare systems management specialization from Loyola University.

Congratulations to University Medical Center of El Paso for becoming the first hospital in Texas to complete the new maternal verification survey, which was conducted earlier this fall with Texas Perinatal Services. We recently sat down with UMC El Paso Director of Women’s Services Gloria V. Delgado, MSN, RNC-OB, to get her insights into their maternal survey experience.

Read about their experience in this best practice case study.

Last week, both the U.S. House of Representatives and Senate passed H.B. 1318, the Preventing Maternal Deaths Act of 2018. The bill now awaits the president’s signature. This bill authorizes the Department of Health and Human Services to make grants to states intended to help improve maternal healthcare and reduce maternal deaths. Under the bill, states could be awarded grants to:

(1) Review pregnancy-related and pregnancy-associated deaths (maternal deaths);

(2) Establish and sustain a maternal mortality review committee to review relevant information;

(3) Ensure that the state department of health develops a plan for ongoing healthcare provider education in order to improve the quality of maternal care, disseminate findings, and implement recommendations;

(4) Disseminate a case abstraction form to aid information collection for HHS review and preserve its uniformity; and

(5) Provide for the public disclosure of information included in state reports.

If the bill becomes law, states will be tasked with developing procedures for mandatory reporting to their departments of health by health facilities and professionals concerning maternal deaths and for voluntary reporting of such deaths by family members. In addition, the bill requires states to investigate and prepare a case summary for each case, to be reviewed by the committee and included in applicable reports. The bill amends the Public Health Service Act to direct HHS to take specified steps to eliminate disparities in maternal health outcomes.

The bill defines “pregnancy-associated death” as the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy, irrespective of the cause of death. It defines “pregnancy-related death” as the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy, irrespective of the pregnancy’s duration, from any cause related to, or aggravated by, the pregnancy or its management, excluding any accidental or incidental cause.

Read the full bill text.

At Texas Perinatal Services, we pride ourselves on hiring only Texas-based, Texas-experienced clinicians for our survey teams. Why is that important? Because, unlike clinicians whose frame of reference may come from other regions of the country, our surveyors understand the unique challenges of delivering healthcare in a state as large and diverse as Texas.

Dr. Elly Xenakis is one of those seasoned Texas maternal care experts, and we are proud to have her on our survey team. She recently shared some insights on the new maternal care rules and what hospitals need to know as they undertake this journey.

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How will hospitals – and more importantly, their patients – benefit from the new maternal care verification surveys and designation rules?

The new rules are going to improve the safety of patients and the level of care they receive. They also give patients an opportunity to access the appropriate level of care they need.

Why did you choose to become a TPS surveyor?

As an experienced physician and a Maternal-Fetal Medicine/OB-GYN specialist, I can offer insights and understanding by being a surveyor. I am also learning through this process and can facilitate improvement locally and state-wide.

I chose Texas Perinatal Services/TETAF because they are Texas based. That’s where I live, where my patients are, where my heart is.

What was it about Texas Perinatal Services that attracted you?

Texas Perinatal Services/TETAF is a Texas-based organization with surveyors knowledgeable about urban and rural realities of Texas.  TETAF has served Texas for a very long time and our teams are very knowledgeable and their experience adds value to the services delivered by our maternal care facilities throughout Texas.

Tell us about your experience so far in surveying maternal care programs.

As an OB-GYN who specializes in high-risk patients, I find that I am learning just as much as the hospitals. I have been very impressed and enlightened by this process. The dedication, commitment and collaboration among the providers, the administration and the hospitals themselves is impressive. They share a common goal to provide the best of care for women and their children.

As we go through the process, we are together enhancing knowledge. We are here to facilitate and what we are doing through the surveys is to corroborate and enhance the opportunities for every hospital to provide the best care for the mothers and their children. This process helps everybody.

What experience do you bring to your role as a surveyor that you hope will be beneficial to the hospitals and clinical teams you survey?

I have spent my career in a county hospital which gives me a unique perspective about serving an underserved population. I serve a population with very diverse needs. We have a lot of outreach and transfers, and I see the conditions and needs of rural Texas communities. Over my 28 years in San Antonio, I have had the opportunity to work with every level of maternal care in South Texas and I think that is valuable experience in my survey role.

Any advice to hospitals as they prepare for their first maternal survey?

Become familiar with the requirements for designation. Know the process and what’s required for your hospital. You need to be very well prepared and diligent as you get ready for the survey. I encourage people to contact their Regional Advisory Councils and talk to others who have gone through their survey already. Take advantage of the TETAF/Texas Perinatal Services resources that are available through their website. They have produced several webinars that are online, and lots of information can be found on their site.

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About Dr. Xenakis

Elly Marie-Jeanne Xenakis, MD, is board certified in maternal-fetal medicine and obstetrics-gynecology. She completed her fellowship in San Antonio and has taught and practiced medicine there for nearly three decades. She has received numerous teaching and mentorship awards, and has been named one of the best doctors in America, a “Texas Super Doctor”, and most recently, one of the best doctors in San Antonio, Texas.

DSHS is accepting applications for membership on the Maternal Mortality and Morbidity Task Force for the following positions:

• Community advocate in a relevant field
• Physician specializing in obstetrics
• Epidemiologist, biostatistician, or researcher of pregnancy-related deaths
• Physician specializing in family practice  

Applications must be received by January 1, 2019.

The application and additional information can be found on the DSHS website.